| NPI | 1831193515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD0000031971) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G70314) |
| 207W00000X Ophthalmology (Licence: KY 29092) | |
| 207W00000X Ophthalmology (Licence: GA 047881) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2020-04-28 |